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SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: agS 21k,6 DATE RECD AT LAB: + `��f'y� For Regalatory Purposes? <br /> REC.BY(PRINT) L .A. TIME RECD AT LAB' p DRINKING WATER YES I NG <br /> WORKORDER: -T, ^k or-6 5-s'°j_ DATE LOGGED IN L4.-.a WASTE WATER YES/NO <br /> (For clients requiring preservation checks at receipt,document here ) <br /> CIRC(_Ir THE APPROPRIATE RESPONSE LAB DASH CLIENT ID CONTAINER PAESERv pH SAMPLE DATE REMARKS- <br /> SAMPLE# # DESCRIPTION ATIY>_ 14ATRIX SAMPLED CONDITION(ETC) <br /> 1 Custody Seal(s) r ent b a e n t w--1 Y0 L <br /> /Broken* 1 ,.2 <br /> 2. Chain-of-Custody res 1 Absent <br /> S. Traffic Reports or <br /> Packlng List E6186 1 Abse -5, <br /> 4 Airbill Sticker _6 <br /> ?P;0resen Absent - <br /> 5 Airbill* bio rcw S I <br /> 6 Sample Labels /Absent -- <br /> 7 -Sample IDs Lis 1 Not Listed <br /> ain-of-Custody --3 <br /> 8 Sample CondibonIntac 1 Broken*/ <br /> Leaking* l3Zo �- <br /> 9. Does information on chain-of-custody, <br /> traffic reports and sample lalze s <br /> a roe? Ye /No* <br /> 10 Sample received within <br /> Fold time? Y 1 No* <br /> 1 f Adequate sample volume <br /> receival)? (--Ycd/No* <br /> i2 Proper preservatives <br /> used? Ye I No` <br /> 1 rip BI emp-11ank deceived? <br /> circle which,if t e /No* <br /> 14 Temp Rec at Lab &�?c <br /> is temp 4+/-2°C? Ye * <br /> (Acceptance range for samples requiring thermal pros) <br /> "Exception(if any) METALS 1 DFF ON ICE= <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION <br /> -SRL Revision e <br /> Replaces Rev 5(06/07/04) Page�of/-- <br /> Effective 07/13104 <br /> I <br />